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General NPI Number Information
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NPI Number | 1366983140
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Entity Type | Organization
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Legal Business Name | MEDICAL ALLIED NURSING ACADEMY, INC.
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Dates
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Enumeration Date | 03/14/2017
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Last Update Date | 03/14/2017
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Provider Practice Location Address
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Address Line | 750 PLAZA ORANGE BLOSSOM TRAIL SUITE 264
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City | ORLANDO
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State | FL
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Zip | 32805
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Country | US
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Telephone | 407-440-8696
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Fax | 407-440-8696
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Provider Business Mailing Address
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Address Line | 928 SPRING LAKE SQ
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City | WINTER HAVEN
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State | FL
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Zip | 33881-1352
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Country | US
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Telephone | 407-440-8696
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Fax | 407-440-8696
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Authorized Official
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Title or Position | PRESIDENT /ADMINISTRATOR
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Name | KATHIANA ANN BAZILE
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Credential | CNA
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Telephone | 407-440-8696
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 311Z00000X
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Taxonomy Name | Custodial Care Facility
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License Number | NR 12345
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License Number State |
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Taxonomy #2
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number |
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 315P00000X
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Taxonomy Name | Intellectual Disabilities Intermediate Care Facility
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License Number | P13000025575
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License Number State | FL
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Taxonomy #4
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | 31400000X
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License Number State | FL
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